Holistic Rooms

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COVID-19 pre-screening questionnaire

(please complete no more than 24 hours before your appointment)


  1. Experienced a new cough that you cannot attribute to another health condition?      YES / NO
  2. Experienced new shortness of breath that you cannot attribute to another health condition?  YES / NO
  3. Experienced a new sore throat, loss of taste or smell that you cannot attribute to another health condition?  YES / NO
  4. Had a temperature at or above 37.8°C or the sense of having a fever?  YES / NO
  5. Had close contact with someone who is or was sick with suspected or confirmed COVID-19? (Note: Close contact is defined as within 6 feet for more that 10 consecutive minutes)  YES / NO
  6. Within the last 14 days, have you or a household member been isolating?  YES / NO


If you answer YES to any of these questions, please reschedule your appointment

I have read The Holistic Rooms COVID-19 Guidelines/Procedures, which outlines the measures The Holistic Rooms have taken to minimise risks to clients and understand there are theoretical risks in attending your treatment and agreed to attend the treatment. 


Name: _____________________________________

Signature: _____________________________________

Date: _____________________________________


COVID-19 Guidelines/Procedures

To provide you with a clean and safe environment that adhere to the government guidelines, the following has been put into place to keep staff and clients safe. Guidelines may be subject to change, you will be updated of these changes.



  • The treatment room has been thoroughly cleaned and all equipment has been sanitized. The treatment room and all equipment will be cleaned and sanitized in-between each client.

  • We are unable to provide blankets and extra cushions as these cannot be washed and disinfected in-between clients so please bring something that you can put on to keep you cosy and warm if you wish to. Bolsters will be provided to give extra support as these are non-porous and can be disinfected.

  • The treatment room will be ventilated by having a window slightly open at all times as long as it's not too noisey outside and will disturb your relaxation.

  • Hand sanitizer, paper towels and tissues will be available for you to use. Masks will also be available for you to use only if you wish to wear one. A lined pedal bin will be in the room for you to dispose of these items.



All staff will be wearing face masks.

  • All equipment will be sanitized, cleaned and disinfected between every client.

  • Treatment room will be cleaned, sanitized and disinfected between each appointment.

  • 1 mask per client will be available for you to wear during your treatment if you wish to wear one.

  • Hand sanitizer and hand washing facilities will be available throughout the building and in the treatment room.

  • Refreshments will be provided in disposable cups.



  • Only you can attend your treatment slot, unfortunately there will be no waiting area so please arrive on time for your appointment slot.

  • We still need a signed signature on our consultation form before we start your treatment so please bring your own pen to sign with.
  • If you or anyone else in your household has Coronavirus symptoms, then please reschedule your appointment. T&C’S apply.

  • Our toilets will be in use for you and are cleaned and sanitized after every use so you can be as comfortable as possible throughout your treatment.



  • You will be warmly greeted but sadly hugs and handshakes will have to be put on hold…for now :)

  • You will be encouraged to use hand sanitizer/hand washing facilities as you enter the premises or before treatment.



  • We will take payment in the treatment room, I am happy to take cash and bank transfer.

  • I will rebook your next appointment as normal for you, however no appointments will be written down so please make a note of it on your phone or bring a little paper and a pen to write your next appointment down.

  • Payment is by cash or bank transfer. I am unable to except card payments.



  • We reserve the right to amend or adjust these guidelines based on Government policy and new research to protect the safety of staff and client.

  • We will not be taking appointments for children for the time being.


'Life sends you good things whether you are grateful or not. But with gratitude, life sends them faster. That is because gratitude is a state of being' - Neale Donald Walsch